"No One Knows What to Say When I Share I Tried to Kill Myself" and Client Centered Therapy
As a therapist, I better know what to say or do when a person shares that he or she is suicidal. I have been professionally trained on how to respond. It is not at all unusual for me to learn that a person is actively considering suicide during a therapy session. And the truth is that unless someone is completely disabled to complete suicide, it is an option that is readily available to all of us. There used to be a TV show called "1,001 Ways to Die," which was about deaths by accident as a result of some foolish act. There are at least as many ways to complete suicide. When I do a lethality assessment, one of the questions on most psychotherapy notes is whether the person has the means to act. I find that to be a ridiculous question. Of course the person has the means to complete suicide. It does not take much imagination. The salient question is "why?"
Client Centered Therapy is based on the principle of understanding a problem or situation from the client's perspective. If a person is suicidal, I have found that there are most likely a host of reasons that brought the person to the point where suicide looks like the only viable option. For the therapist to minimize a client's feelings of desperation is the opposite of being client centered. It is a dis-service to the client and is likely a reflection of the therapist's own feelings of fear and insecurity that their worst experience as a professional might come true. A therapist needs to demonstrate that he or she is not flustered by the knowledge that his or her client is feeling suicidal. Admittedly, it is challenging for the therapist to deal with a life or death situation. But if that rattles a therapist, perhaps he or she is in the wrong profession.
In order to make a truly professional assessment of whether a person is in imminent danger of suicide, it is necessary for the therapist to understand the thoughts and feelings of the client. Often times, there is a logical progression of negative thoughts with associated feelings that lead to the conclusion that suicide is the only option. Certainly, clients who are suffering with pain and agony due to a terminal illness might consider suicide the best option. There are countless situations in which suicide may appear to be the only answer. It is imperative that the therapist stay with the client on this dark journey of desperation and despair. Once the client feels (and I use 'feels" intentionally) that the therapist is in tune with their point of view, a rational discussion about suicide can be had. Now we have a therapeutic alliance and we can have an honest discussion about whether it is true that suicide is the only or best option. I have found that the willingness to go there by the therapist is, in and of itself, therapeutic. This is what it means to be client centered.
If I had the opportunity to have met Sonia when she was feeling suicidal, I would have asked, "Please help me understand: Why do you feel suicidal?" I would not have been reaching for my cell phone to call 911. Of course, if I made the assessment that Sonia is in fact an imminent danger, I would use all resources to keep her safe. That is the last resort, not the first.
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